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You are not alone, Mr Whittle. Your point is entirely pertinent. In my discussions with the chief medical officer, there was no strong view that this must be done in a particular way. However, there was an absolutely clear understanding that both aspects would need to be captured on the death certificate. My amendments propose one way of doing that, and Pam Duncan-Glancy has helpfully given the committee an opportunity to consider an alternative way of addressing the issue.

At this stage, rather than leave the issue unresolved from my perspective, I will press my amendment, but I give the assurance that I am happy to work with Pam Duncan-Glancy and others at stage 3 to see whether further refinements are needed in order to address the points that she and Brian Whittle raised. It is difficult stuff, but I do not believe that the difficulty is insurmountable. However, it is important that the bill is amended at stage 2 to address what I think is a shortcoming in its drafting.

On that basis, I will press amendment 36.

Amendment 36 agreed to.

Amendment 246 moved—[Pam Duncan-Glancy].

I thank Stuart McMillan for setting out the rationale behind his amendments. I echo his point about the importance of the openness of the conversations that ideally should happen. In earlier groups, we had quite a bit of discussion about anticipatory care plans. Underlying all of this is the desire for more people to take more care in setting out their wishes and discussing them with loved ones or family and friends as early as possible.

I, too, have engaged with the Salvation Army, although much earlier on in the process and not specifically in relation to this issue. I am not aware of the issue being raised at stage 1 or in the consultation on my proposals way back in 2021. I note that, in Scotland, unlike in England and Wales, there is no specific statutory offence of assisting somebody’s death. Therefore, I consider that the bill’s provisions are sufficient in providing protection from civil liability, and I urge Stuart McMillan not to press amendment 250 or to move amendment 251.

As I said, I am not sighted on more of the background to the issue, and the Salvation Army might be able to help me with that, along with Stuart McMillan, so I am happy to continue those discussions. However, at this stage, I do not see the need for the amendments.

I appreciate that. As you will be aware, we have added a number of for-the-avoidance-of-doubt provisions to the bill through various amendments, so I am certainly not averse to doing that. However, I would need to have a better understanding of what we are seeking to achieve with the amendments. Even if they are for the avoidance of doubt, there are potential risks that we could cause more confusion in trying to go down that route. However, my offer is there.

I thank Murdo Fraser and Miles Briggs for talking through their amendments. The bill contains offences relating to coercing or pressurising a terminally ill adult into requesting assistance and it also provides that it is not a crime to provide assistance under the provisions of the act and that there is no civil liability for doing so.

It therefore follows, as you suggested in your intervention, convener, that there remains criminal and civil liability if a person is provided with assistance outwith the provisions of the bill. If any person believes that another person has been provided with assistance who has not been eligible for such assistance to be provided, it is a criminal matter and should be reported to the police and investigated by the relevant authorities. I appreciate the point that, more often than not, it might be family members who have such concerns, but I do not think that we should say that the right to call for an investigation needs to be reserved entirely to them.

It is perhaps worth reflecting that, in the stage 1 evidence that was taken on the role of the COPFS Scottish fatalities investigation unit in investigating fatalities on behalf of the Lord Advocate, the view of COPFS was that independent scrutiny would already exist. As members will recall, the committee heard at stage 1 about the role of the unit in investigating all deaths in Scotland that are sudden, suspicious, unexpected or unexplained. Indeed, the head of the investigation unit set out the independent scrutiny of the circumstances of death that currently exists, covering not only potential criminality but wider investigation to establish any systemic issues or issues of public concern requiring further investigation. COPFS also confirmed to the committee that medical practitioners are already provided with guidance on the deaths that require to be reported to the Crown Office.

I note that the Scottish Government highlighted various drafting and resourcing issues with amendment 189, and I urge Murdo Fraser not to press that to a vote.

Miles Briggs’s amendment 200 would establish an assisted dying review panel to review whether the act is complied with in each case and analyse information that is provided. I agree with his points about the importance of learning from the way in which the act is developing, and some of the data gathering that we referred to in earlier groupings will help to facilitate that. I am not opposed to the principle, but I am concerned that any such oversight panel might duplicate existing roles or processes. I have already touched on and set out in detail the evidence from COPFS and the responsibilities of the Scottish fatalities investigation unit.

The Scottish Government also notes that amendment 200

“seems to cover a similar role as the provision under Section 27”,

and that amendment 214 is consequential to amendment 200.

At this point, I do not believe that the review panel necessarily adds an additional safeguarding layer. There might be elements in what Miles Briggs is trying to get at with the review panel that might be helpful in augmenting what is already in section 27, but, at this stage, I encourage Miles Briggs not to move amendment 200, and I urge the committee not to support it.

I apologise, convener—I should have done this at the outset of proceedings. Having listened to Miles Briggs make his declaration of interest, I remind the committee that I am supported by Dignity in Dying Scotland, Friends at the End and the Humanist Society Scotland.

I understand what Sue Webber is saying, but I also note that this concern has been raised as a result of representations made by the BMA, which represents many of these medical professionals. The BMA makes strong arguments about many aspects of this bill, and the other bills that are going through legislatures around the UK, which are about ensuring that we do not cut across appropriate medical discretion and judgment and that we take care about interfering with the doctor-patient relationship.

Sue Webber is absolutely right—Jackie Baillie made the same point—about how integral that relationship can be, particularly for someone who has a terminal illness and who has therefore probably been under treatment with the support of not just one medical professional but possibly a team of medical and other professionals. Those relationships are very important. However, within that, it is important to allow professionals, using their training and experience, to exercise their judgment in an appropriate way.

I do not disagree with the point that Bob Doris has just made, which he made earlier, about the importance of the framework. We perhaps disagree about the extent to which there is a framework, but it is part of the stage 2 and stage 3 processes to decide, even if there is a framework, whether we need to buttress that further. However, whatever framework we set, we need to allow scope for clinical judgment, based on appropriate training. We have covered some of the training aspects that are linked to the bill, and further strengthening might be required in some areas, but that all speaks to the need to allow judgment to be exercised.

That exchange was, if somewhat unusual for stage 2 proceedings, very helpful. It is probably worth reiterating that the bill is predicated on a terminally ill adult requesting assistance to begin the process. On the point about Dignitas that Miles Briggs referred to, in relation to his amendment, because that is not a procedure that is covered by the bill, there would not be a protection in relation to that. Therefore, to some extent, that issue remains pertinent. We need to allow discretion and medical judgment to apply and to avoid creating an environment in which assistance under the legislation becomes stigmatised or is not subject to free, open and transparent consideration.

As it stands, the bill almost certainly covers that. To some extent, Miles Briggs’s amendment might be more for the avoidance of doubt, but the debate that we have had on it has, if nothing else, perhaps demonstrated the need for greater clarity on that, and I am certainly sympathetic to that.

Turning to Jackie Baillie’s amendment 53 and Daniel Johnson’s amendments 53A and 53B, I note that Sandesh Gulhane’s amendments to change the eligibility age from 16 to 18 have been agreed to, which means that no person under the age of 18 will be eligible to request assistance under the legislation. I have previously set out why I do not support changing the age limit to 25.

As I have made clear, the bill does not require, nor does it actively permit, any health professional to raise assisted dying with a person. It is predicated on a terminally ill adult requesting assistance to start the process. That said, I absolutely accept some of the arguments that Jackie Baillie and CHAS have been making about how the process for younger people will almost certainly be very different, in every instance, from the process for somebody in later life with late-stage cancer or whatever it may be.

That said, I ask members to consider whether amendment 53 is necessary, given that those under 18 are not eligible to be provided with assistance. I suppose that the same factors apply in relation to Daniel Johnson’s amendments. The rationale for introducing them relates to a point that I have accepted before: the training that will be required for the practitioners involved is likely to be different from that relating to patients at a later stage, and some of how the process works in practice will almost certainly be different, not least because a wider team is likely to be involved—not just medical practitioners but social work and other experts in particular fields.

Aside from those observations about the age limit, which we have already discussed, I have no strong views on the amendments in this group.

That is a very fair point to raise. It has not been raised with me either in the context of the bill as introduced or in relation to the additional safeguard that I seek to introduce through amendment 33. I am prepared to engage with other members and representatives of the medical profession to see whether any anxieties in relation to that point still need to be addressed. However, as I said, there is a safeguard in the bill. Notwithstanding Mr Whittle’s—rightly made—point about our legal set-up in Scotland, I believe that the safeguard is appropriate. As I said, it balances the need to ensure self-administration and that there is no evidence of coercion with respect for the right of an individual to have the privacy that they wish to have at the end of life.

I turn to the amendments that Brian Whittle lodged on the role of the pharmacist in the provision of the substance under section 15. I remind members that section 15 details that the co-ordinating registered medical practitioner or an authorised health professional can provide the approved substance if specified conditions are met. Amendment 173 would provide that the approved substance could

“only be supplied to a coordinating registered medical practitioner or an authorised health professional”

for that purpose

“by a registered pharmacist, in accordance with the directions of the coordinating registered medical practitioner.”

Amendment 173 is one that I can support on the understanding that it would not add to the competence issues that are being considered by the Scottish and UK Governments.

Amendment 177 would enable the co-ordinating registered medical practitioner or authorised health professional, where they are

“accompanied by any other health professional”,

which, as per section 29, could be a registered medical practitioner, a registered nurse or a registered pharmacist, to

“delegate their functions under subsections (1) and (7)”

of section 15 to that person. Section 15(1) deals with the provision of the approved substance, and section 15(7) deals with the removal of the substance where the terminally ill adult decides against using it.

However, amendment 175, which I understand should be read with amendment 177, would require that the co-ordinating doctor or authorised health professional, as the case may be, has to be present for the provision of the substance.

I believe that Mr Whittle’s intention is that it would be the role of a pharmacist to provide the substance to the person. However, I believe that there is merit in retaining the provision that it is for the co-ordinating registered medical practitioner or authorised health professional to provide the substance. I envisage the role of any other health professional attending at the discretion of the co-ordinating registered medical practitioner or authorised health professional to be limited to providing assistance to the CRMP or AHP as they see fit. I am wary of allowing functions under section 15 to be delegated by the CRMP or AHP, who must be in attendance and who will have the relevant skills, training, experience and qualifications to fulfil the functions set out in subsections (1) and (7) regarding the provision or disposal of the substance.

Amendment 185 would add registered pharmacists to the definition of an authorised health professional in section 15. I note that the Government suggests that, in order to fulfil that role, pharmacists would likely need additional training over and above that required by the doctors and registered nurses who fulfil the role. I agree with that assessment, and I note that, if the amendment is agreed to, there would be no distinction between who can be an authorised health professional in section 15(8) and a health professional as defined in section 29, which could lead to confusion.

I turn to Jackie Baillie’s amendments 76 to 79, which would require that, where the substance is to be provided by an authorised health professional who is a registered nurse, they must be accompanied by the co-ordinating registered medical practitioner or another AHP who is a registered medical practitioner. It would be for the CRMP or AHP who is a registered medical professional to make the determinations on a person’s capacity and whether they were being coerced. The registered nurse would have to be accompanied by another health professional for the purposes of subsections (5) to (7) of section 15.

The bill provides for the role of an authorised health professional to ensure that there is no unreasonable delay or barrier to a person who is eligible being provided with assistance. Limiting the section 15 role for a registered nurse in the way suggested might lead to such delays and a loss of access for some terminally ill adults. The bill requires the authorised health professional to be a registered medical practitioner or a registered nurse, authorised by the co-ordinating RMP. The co-ordinating RMP therefore already has a key role in deciding whether to appoint an authorised health professional.

Having engaged with the RCN, I have lodged amendments requiring the Scottish ministers to be able to regulate for any training, qualifications and experience that a registered medical practitioner or registered nurse should have in order to carry out the role of AHP. I believe that, if agreed to, the amendments will help to ensure that the role will be suitably supported. I should note that the amendments that I have lodged to section 18 are also relevant here in that they would ensure that no person would have to participate if they did not want to for any reason. I therefore do not believe that amendments 76 to 79 are necessary or would strengthen the bill—in fact, they could limit the availability of relevant health professionals who are able to provide the substance and be with the person on the day of death. The Scottish Government also appears to have noted that, while observing that such an approach

“may set a precedent of health and care professionals being accompanied when they have to attend people in their homes to deliver other services.”

The resource implications of that could be significant.

As I have said, I understand the rationale behind the argument, particularly as we are dealing with the introduction of new legislation. I am just concerned about putting in place something that then prevails but which, in turn, reduces access to choice in what I believe is a disproportionate way.

The example that the convener and Jackie Baillie have cited is certainly the case. However, there are many instances in which that provision is not required, and yet additional nurses are still present to provide whatever support is felt to be necessary. Their doing so is not a statutory provision. This is all about striking a balance by allowing this to happen, in the expectation that, in the early stages, it might well be the case more often than not, but without binding it in statute as a requirement that could have an impact on being able to access that choice.